What's changed in DSM-5-TR and why EHRs need to keep up

The DSM-5-TR is a living document — and its updates have real clinical stakes

Behavioral health professionals know all about the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. Published by the American Psychiatric Association (APA), the current version of the DSM — DSM-5-TR — defines diagnostic criteria and clinical terminology and provides any updated standardized medical codes — known as ICD-10-CM codes — used to document and bill for mental health conditions.

What's less widely known is that the DSM-5-TR — which is the text revision of the earlier DSM-5 — isn't static. The APA releases annual supplements each September that update codes, revise terminology, and refine diagnostic criteria. And those changes take effect whether your practice — and your Electronic Health Record (EHR) system — is ready or not.

The 2024 update replaced single codes for anorexia nervosa, bulimia nervosa, and binge eating disorder with condition-specific severity and remission codes. The 2023 update revised differential diagnosis language for schizophrenia and conduct disorder. The 2022 update overhauled neurocognitive disorder coding entirely.

When these changes happen, discontinued codes, coding discrepancies, and shifts in diagnostic specificity can create significant compliance challenges. Does your behavioral health EHR know that?

What the September 2025 supplement contains

Here are some important changes¹ in the September 2025 DSM-5-TR update:

• Standardized language across "Other Specified" diagnoses: Across six mental disorder categories — bipolar, depressive, somatic, eating, insomnia, and delirium — the APA standardized how clinicians should record presentations that don't fully meet diagnostic criteria. The update replaces inconsistent shorthand with a consistent "-like" suffix convention. "Cyclothymia" as a standalone descriptor becomes "cyclothymic-like disorder." "Short-duration depressive episode" becomes "depressive-like episode." "Bulimia nervosa of low frequency" becomes "bulimia nervosa-like disorder."

For behavioral health practices, "Other Specified" designations are routine. They show up frequently in documentation for patients whose presentations are real and clinically significant but don't meet full criteria. Documentation that still uses the older phrasing may not be aligned with the current standard. And in a multi-provider practice, that inconsistency could compound across every clinician using the same templates. 

• A reframing of clinical authority in substance use documentation: Across the Substance Use Disorders chapter, the word "endorsed" — implying symptoms a patient self-reported — was replaced with language that explicitly centers the clinician's assessment. Severity is now framed as based on criteria "that have been met," reflecting the provider's judgment rather than patient self-report alone.² It's a detailed change, but it may have real implications for how severity is documented, communicated to other providers, and supported in the record.
• An expanded Z-code for moral and spiritual problems: The "Religious or Spiritual Problem" category (Z65.8) was broadened to "Moral, Religious, or Spiritual Problem" — adding moral dilemmas, distress, and injury as valid clinical attention foci. For behavioral health practices, this creates a documentation pathway for presentations that previously didn't have a clean fit¹.

Why the changes matter

For behavioral health practices, these changes affect the language clinicians use to document care, the codes used to communicate diagnoses, and the templates that shape how information flows across a practice. When a practice's EHR falls behind, the effects ripple across every clinician using the same system, every documentation workflow built on outdated terminology, and every record that needs to travel clearly between providers and care settings.

The downstream effects of DSM-5-TR updates show up in three concrete places:

• Documentation consistency: If EHR templates still offer "cyclothymia" as shorthand when "cyclothymic-like disorder" is now the standard, every clinician using that template may be documenting inconsistently with current clinical language. Across a group practice, those inconsistencies can compound fast.
• Coding validity: When a diagnosis code changes — as it did with eating disorder severity codes in 2024 — the prior code may not just be imprecise. It may become noncompliant. This is the kind of change that needs to be reflected in the system, not flagged in a staff email.
• Cumulative burden: Four supplements in four years. No single year is overwhelming. But together they represent a sustained maintenance obligation — one that lands on clinical and operations staff when behavioral health technology doesn't help absorb it.

What happens when your EHR system lags

When clinical standards update and your EHR doesn't, the gap could land on whoever is documenting. Clinicians work around outdated dropdown options. They add manual notes to clarify what a legacy term means. They may default to "unspecified" — because the updated language isn't in the system.

Across a group practice, all of this creates significant inconsistencies. The same clinical presentation is documented differently by different providers, based on what their system offers rather than what the standard says. In behavioral health, where care often spans multiple providers, settings, and care team members, inconsistent terminology affects how clearly information travels across the record. It also affects how confidently clinicians can act on it. And when clinicians are spending time navigating workarounds instead of focusing on patients, everyone in the care relationship feels it.

The burden of manual compliance tracking shouldn't fall on clinical and operations staff who are already stretched.

The efficiency that comes with the right technology partner

A cloud-based EHR doesn't eliminate the need to stay current, but it can certainly assist clinicians in their efforts to do so.

When updates are maintained centrally and deployed across a network, practices don't have to parse a supplement, identify which changes affect their workflows, update templates, and brief every provider before a deadline. That maintenance loop often happens at the platform level — not necessarily at the practice level.

DSM-5-TR updates affect how practices document care, communicate diagnoses, and maintain consistency across workflows. That means the technology supporting those workflows has to keep pace. As a cloud-based technology partner, athenahealth is actively working to reflect these changes in athenaOne®, so practices aren't left tracking the delta themselves.

The APA releases a new DSM-5-TR supplement every September. Your EHR should have a plan for keeping pace.

There will be a September 2026 supplement. And a 2027 one. The practices best positioned to stay current won't be the ones with the most diligent staff manually monitoring APA releases. They'll be the ones with a platform doing that work in the background — so their teams can focus on care.

Learn how cloud-based EHR technology can support behavioral health practices. And see how one practice streamlined behavioral health documentation with athenaOne®.